Long-term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy.

Autor:	Visser NC; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands., Sparidaens EM; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands., van den Brink JW; Department of Obstetrics and Gynecology, Canisius-Wilhemina Hospital, Nijmegen, The Netherlands., Breijer MC; Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands., Boss EA; Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands., Veersema S; Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands., Siebers AG; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands., Bulten J; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands., Pijnenborg JM; Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands., Bekkers RL; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
Jazyk:	angličtina
Zdroj:	Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2016 Dec; Vol. 95 (12), pp. 1418-1424. Date of Electronic Publication: 2016 Oct 14.
DOI:	10.1111/aogs.13022
Abstrakt:	Introduction: Women with postmenopausal bleeding and endometrial thickness >4 mm undergo endometrial sampling to exclude endometrial cancer. The aim of this study is to investigate the relative risk of developing endometrial cancer in a prospective cohort after initial work-up for postmenopausal bleeding showing reassuring histology or insufficient sampling. Material and Methods: All women presenting with postmenopausal bleeding were prospectively included from January 2009 to April 2011. Follow-up data were collected from patient charts and PALGA (Dutch Pathology Registry). Hazard ratios for endometrial cancer were determined by calculating standardized incidence ratios. Results: A total of 668 women were included and 568 women were available for follow-up [median follow-up time 47 (range 7-63) months]. Women who presented with postmenopausal bleeding, endometrial thickness >4 mm and hyperplasia without atypia on biopsy at the first presentation showed a significantly increased risk (standardized incidence ratio 17.15, 95% confidence interval 1.96-61.93) of being diagnosed with endometrial cancer during the first four years of follow up compared with the age-specific population. All women that developed endometrial cancer after initial reassuring histology presented with recurrent postmenopausal bleeding. None of the women with endometrial thickness >4 mm and no or insufficient sample for histology at the first presentation developed endometrial cancer during the follow up. Conclusions: Although in general, women with endometrial hyperplasia without atypia are considered to have a low risk for cancer, we observed a significant long-term risk of endometrial cancer after postmenopausal bleeding. Whether additional diagnostics or a more stringent follow-up regimen would be cost-effective, needs to be studied. (© 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
Databáze:	MEDLINE
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